Overview

Simulation Center faculty and medical educators developed a Point-of-Care Ultrasound (POCUS) curriculum to address the learning needs of residents across a spectrum of medical specialties.  The aim was to integrate learners from different backgrounds to improve bedside ultrasound skills that residents can utilize in their medical careers.

Organization Name

HCA- Grand Strand Health

Organization Type

• Academic Hospital
• Community health system

Local/Organizational Context

• The team identified a lack of POCUS teaching across residency facilities nationwide.  
  • Very few programs have an integrated system through which bedside ultrasound training is made available to residents from a variety of backgrounds. 
  • The team sought guidance from the Montefiore-10 curriculum for Internal Medicine residents and added a simulation component for the addition of a high level of realism within POCUS teaching. 
• Bedside ultrasound helps better stratify which patients will require a formal ultrasound assessment versus those who can safely avoid an additional radiological examination.

Patient Population Served and Payor Information

• Patient population is primarily rural, underinsured or with Medicare/Medicaid coverage.  

Funding

• HCA has been extremely supportive of our mission to provide cost-effective, efficient care for patients and have actively supported the residency leadership’s goals to bring POCUS learning to resident learners.

Tools or Products Developed

• Montefiore-10 learning curriculum for an ultrasound 
• SonoSim platform to teach pathology related to a variety of conditions

Tech Involved

• Software Program

Team Members Involved

• Physicians
• Support Staff

Workflow Steps

• The team provides a hands-on, small group or one-on-one environment in which resident, student and nursing learners have access to an ongoing curriculum of ultrasound-based learning tools and scenarios to enhance the ultrasound learning experience.  
• Residents, medical students, and nurses join a Simulation Lab or Skills Lab in the Education Center and follow a curriculum of ultrasound learning activities to enhance learning and obtain prescribed objectives.  The learners then take their skills to the bedside in the hospital or clinic setting within our community health system.
  • The resident course is  36 months of training.  They work with patients throughout their training in the simulation lab and take their POCUS skills back to the bedside to augment the physical exam and understanding of the pathophysiology of ongoing issues with the patient.  
  • Students are evaluated on a one-on-one basis throughout the 36-month program to assess for efficiency and accuracy in ultrasound based skills.
• Residents are trained using a variety of resources across the country.  Despite the rise of ultrasound use at the bedside across the spectrum of medical practices, only a small minority of residency programs have an integrated ultrasound curriculum for their residents to take part in, and even fewer utilize this learning tool across multiple medical specialties.  

Budget Details

• All supplies have been procured at this time.  There are no additional costs required by the objectives of this project.  Majority of upfront costs included purchase of ultrasound technology for teaching purposes.

Where We Are

• Date Project Described Started: July 2019
• Date Project Completed: In Progress, completion date June 2021

Outcomes

• Via a validated survey tool, the team assessed resident physician and educator feedback and satisfaction with the curriculum.  They also assess resident physician feedback with regards to confidence with bedside ultrasound practices both before and after completion of the curriculum. 
  •  Residents are extremely satisfied with the program and feel confident in their skills at the end of the 36 month curriculum.

Unique Challenges

• Organization leadership has always fully supported the program.  
• However, innovators have run into issues with buy-in from some of the resident program leadership who may feel bedside ultrasound is of less utility to their resident learners. 
  •  As this is an ongoing endeavor, innovators have focused on outreach efforts to ensure all resident learners have access to the curriculum to enhance their learning as POCUS becomes more prevalent across the medicine spectrum.

Glossary

• POCUS – point of care ultrasound, bedside ultrasound.  A technique using portable ultrasound technology to diagnose common conditions and medical complications rapidly, without any radiation exposure, and painlessly at the bedside.

Sources

• Galen, B. T., & Conigliaro, R. L. (2018). The Montefiore 10: A Pilot Curriculum in Point-of-Care Ultrasound for Internal Medicine Residency Training. Journal of graduate medical education, 10(1), 110–111. https://doi.org/10.4300/JGME-D-17-00683.1